Acne Vulgaris Discussions and Research

Fractional lasers are effective and safe for treating acne scars on darker-hued ethnic skin, a new study has found.

Researchers also found that the scar treatments had a high patient-satisfaction rate.

This study may lead to more patients with acne scars opting for fractional laser treatments. Fractional lasers have become increasingly popular in recent years for their ability to minimize the appearance of acne scars. They work by treating the damaged skin in tiny microscopic columns while leaving the healthy skin between those columns untouched. One of the benefits of this approach is a faster recovery time.

The new study, which was conducted by researchers at King Saud University in Riyadh, Saudi Arabia, involved 82 acne patients with darker-hued ethnic skin. Forty-five of the patients were treated with a nonablative fractional laser, and the other 37 were treated with a more aggressive ablative fractional laser.

The patients were followed for 12 weeks. Both groups experienced about the same amount of improvement in the appearance of their scars (just under 40 percent). Overall patient satisfaction was also similar: 71 percent in the nonablative group and 65 percent in the ablative one.

Both types of lasers “are effective and safe for treatment of acne scars in individuals with dark skin complexion,” the authors concluded.

The study was published in the September issue of the journal Lasers in Surgery and Medicine.

The information found on this website is not designed to replace the patient/physician relationship.

Acne Treatments
Treating acne has been one of the main focuses of dermatology for many years. Even with years of study and research continually looking to improve acne treatments, acne sufferers are often left with only modestly clearer skin. Problem pimples still pop up, zits, blackheads and whiteheads emerge and overall poor complexion is present, the more serious cases of acne can even leave permanent pigmentations and deep pits in the skin, commonly known as acne scarring. Fortunately today we have a variety of at-home medical devices from established companies such as Zeno®, Tria®, Claro® and others which are showing significant results in treating acne. These devices, coupled with the use of topical acne creams, are showing dramatically better results than anything used before. Now millions of acne sufferers can have clear, beautifully smooth skin.

Clearing Acne with At-Home Devices
For many years dermatologists have used lasers, blue light therapy, pulsed light, radiofrequency energy and LHE therapy to target P. acnes, the acne-causing bacteria. These treatments have worked in the dermatologist’s office for years, but the technology to put these devices in the homes of acne sufferers was not yet available. Now due to breakthroughs in both the effectiveness of these devices and the ability to make them more cheaply and smaller, having the power of these acne fighters at home is finally possible.

The Patient’s Guide® to Acne
There are so many different acne creams, products and treatments, both at-home and in skin care clinics, it can be very difficult to know what is right and what is effective. Fortunately the Patient’s Guide®, the leading online publication in cosmetic dermatology has launched Acne.md, our newest website dedicated to educating patients about acne and acne treatments. The Patient’s Guide was launched in 2006 and now comprises more than 25 websites covering the range of skin care issues. We bring you the leading researchers and experts in the field of skin care so you can feel confident in the information we provide. While only a one-on-one consultation with a dermatologist can truly give you an idea of what treatments may be right for you, we aim to at least provide you with an idea of what’s now available.

The information found on this website is not designed to replace the patient/physician relationship.

An article in the March-April 2009 issue of Clinical Dermatology discusses the possible effect of the glycemic index on the prevention of disease, with a particular emphasis on acne. The glycemic index (GI) is a way of ranking the effect of carbohydrates on blood glucose and insulin levels. Although its underlying scientific premise remains controversial, the GI diet has drawn the interest of researchers as well as the public in recent years.

This article points out that although acne is common in Western populations, it is rare in non-Western societies (for example, among the Inuit, Okinawan Islanders, and Kitaven Islanders)—until those societies adopt Western lifestyles. The article then discusses in detail the biological rationale for a possible connection between diet, hyperinsulinemia and acne.

“Recent evidence has demonstrated that the hormonal cascade triggered by diet-induced hyperinsulinemia elicits an endocrine response that simultaneously promotes unregulated tissue growth and enhanced androgen synthesis,” note the article’s authors. “Hence, hyperinsulinemic diets may represent a previously unrecognized environmental factor in the development of acne.”

Source: Berra B, Rizzo AM. Glycemic index, glycemic load, wellness and beauty: the state of the art. Clinics in Dermatology. 2009:27:230-235.

The information found on this website is not designed to replace the patient/physician relationship.

In a comparison study, Korean researchers have found that a combined 585/1,064-nm (sequential dual-wavelength pulsed dye laser [PDL] and neodymium-doped yttrium aluminium garnet) laser is as safe and effective as a PDL laser alone in treating mild to moderate acne (acne vulgaris)

For the randomized, double-blinded, split-face study, which was published in the medical journal Dermatologic Surgery, researchers recruited 16 volunteers with mild to moderate acne. Each underwent 3 treatment sessions at 2-week intervals. At each session, half of their face was treated with a single pass of a combined 585/1,064-nm laser and the other half with a single pass of PDL. Follow-up occurred at 8 and 12 weeks after treatment began.

The results: The inflammatory acne lesions were reduced by 86% on the PDL-alone sides and by 89% on the 585/1,064-nm sides. The observed reductions in noninflammatory lesions was similarly equivalent: 69% and 64%, respectively.

The authors concluded that

“PDL and combined 585/1,064-nm laser were safe and effective for the treatment of inflammatory and noninflammatory acne lesions.”

Source: Jung JY, Choi YS, Yoon MY, Min SU, Suh DH. Comparison of a pulsed dye laser and a combined 585/1,064-nm laser in the treatment of acne vulgaris. Dermatol Surg. 2009. Jan 16.

The information found on this website is not designed to replace the patient/physician relationship.

In a study published recently in the Journal of American Academy of Dermatology, a team of Korean researchers reported that the pulsed dye laser (PDL) and the 1065-nm long-pulsed neodymium:yttrium-aluminum-garnet (Nd:YAG) laser were equally effective in treating atrophic facial acne scars in the same patient.

Eighteen patients were enrolled in the 14-week, single-blinded, randomized, comparative split-face study. Each patient received 4 treatment sessions at 2-week intervals. The board-certified dermatologists who performed the treatments did not participate in outcome assessments. Follow-up occurred at 2-week intervals during the treatment period and at 4-week intervals for 8 weeks afterwards. Acne scar improvements were assessed and scored (based on the ECCA clinical evaluation scale) by two masked dermatologists.

The results: Both types of laser treatments produced notable and comparable improvement in the appearance of acne scars, especially superficial scars. Ice-pick scars (narrow, deeply pitted scars) and boxcar scars (round or oval scars) tended to respond better to PDL and Nd:YAG lasers, respectively.

The authors concluded that both lasers “are effective modalities for the treatment of acne scars. Optimal outcomes might be achieved considering scar types and responses to a specific laser.”

Source: Lee DH, Choi YS, Min SU, Yoon MY, Suh DH. Comparison of a 585-nm pulsed dye laser and a 1064-nm Nd:YAG laser for the treatment of acne scars: A randomized split-face clinical study. J Am Acad Dermatol. 2009 Feb 12. [Epub ahead of print].

The information found on this website is not designed to replace the patient/physician relationship.

A new analysis of data from an earlier study found that an acne medication that was investigated as a possible preventive treatment for skin cancer did not cause the excessive deaths that led to the premature termination of that study.

The earlier study, known as the Veterans Affairs Topical Tretinoin Chemoprevention (VATTC) trial, ran from 1998 to May 2004. It enrolled 1,131 veterans with an average age of 71. Most were men. The participants were randomly assigned to two groups. One group applied a cream containing 0.1% tretinoin (the highest dose available commercially) to their face and ears twice daily. The other group applied a placebo cream.

The retinoid tretinoin, an acid form of vitamin A, is a common topical treatment for acne. It’s sold under several brand names, including Retin-A, Avita and Renova.

The VATTC trial was designed to determine if a high dose of topical tretinoin could prevent certain types of skin cancer in high-risk people. The trial was stopped, however, when an unexpectedly high mortality rate was observed in the study’s treatment arm (82 deaths in the treatment arm versus 53 in the placebo arm).

The authors of the new analysis, which was funded by the U.S. Department of Veterans Affairs and published in the Archives of Dermatology, found no evidence for a cause-and-effect relationship between the tretinoin treatment and the increased risk of death. “We observed an association of topical tretinoin therapy with death, but we do not infer a causal association that current evidence suggests is unlikely,” they concluded.

Source: Weinstock MA, Bingham SF, Lew RA, et al. Topical tretinoin therapy and all-cause mortality. Arch Dermatol. 2009;145:18-24

The information found on this website is not designed to replace the patient/physician relationship.

Epiduo, a new once-a-day prescription gel that combines adapalen and benzoyl peroxide for the topical treatment of mild-to-moderate acne, is now on pharmacy shelves. The gel, which is marketed by Galderma Laboratories, received Food and Drug Administration (FDA) approval late last year.

Both the retinoid adapalen and the antimicrobial benzoyl peroxide have a long history of being used separately to treat acne. Studies have shown that the two treatments are more effective when combined than when either is used alone, reducing total acne lesions by about 18% as early as one week after the start of treatment.

Last year, a 517-patient study published in the Journal of the American Academy of Dermatology reported that Epiduo reduced the median number of total acne lesions by more than 50% over a 12-week period. Another study published in the Journal of Drugs in Dermatology reported that the discontinuation rate of the medication due to adverse events was a low 2%.

Common side effects include dryness, redness (not to be confused with telangiectasia see here), scaling, stinging, and burning.  When using the medication, patients should minimize their exposure to sunlight and other skin products that contain resorcinol, salicyclic acid and sulfer.

Source: FDA: Label and Approval History: Epiduo.

The information found on this website is not designed to replace the patient/physician relationship.

New research showing how combination laser therapy can clear acne lesions was presented at the annual meeting of the American Academy of Dermatology in March.

Macrene Alexiades-Armenakas, MD, of the Yale University School of Medicine, reported on the findings from a small, preliminary study that investigated whether photodynamic therapy (PDT) combined with topical 5-aminolevulnic acid (ALA) and activated by a long-pulse, pulsed-dye laser could effectively clear mild to severe cases of acne.

Eighteen acne patients were recruited for the study. Fourteen received 1 to 6 treatments of ALA PDT, depending on the severity of their symptoms. Each was also prescribed a topical acne medication. The study’s control group consisted of 4 patients. They were treated either with systemic or topical medications or with non-ALA PDT laser therapy.

The acne cleared up completely among all 14 patients in the ALA PDT treatment arm. By contrast, none of the patients in the control group experienced a complete clearance of their acne.

Dr. Alexiades-Armenakas also found a significant improvement in the appearance of acne scars among the treatment group, a result attributed to the penetrating effects of the pulsed dye laser.

Side effects from the combination laser therapy were mild: a slight redness that lasted for about 2 days. No hyperpigmentation was observed, even among patients of color.

SOURCE: American Academy of Dermatology

The information found on this website is not designed to replace the patient/physician relationship.

A new study published in the journal Dermatologic Therapy (2008 Mar-Apr;21(2):86-95) discusses the latest developments in the treatments available for acne. Of great concern recently has been the emergence of antibiotic resistance and the implications of this for the use of topical antibiotics.

In the study by Drs. Katsambas & Dessinioti from the University of Athens Department of Dermatology, treatments alternatives such as low-dose long-term isotretinoin are discussed. Here is an excerpt:

Topical retinoids, benzoyl peroxide, azelaic acid, and topical and oral antibiotics remain the milestone of treatment for mild to moderate acne vulgaris. Oral isotretinoin is useful for the treatment of severe nodular acne, treatment-resistant acne, and acne with a risk of physical or psychological scarring. Hormonal treatment in female acne is useful in resistant or late-onset acne.

With increasing concerns regarding teratogenicity of isotretinoin and increasing antibiotic resistance, there is a clear need for therapeutic alternatives to these long-used treatments. Research in the pathogenesis of acne has allowed for new therapies and future perspectives regarding acne to evolve. They include low-dose long-term isotretinoin regimens, insulin-sensitizing agents, 5alpha-reductase type 1 inhibitors, topical photodynamic therapy, new combination formulations, dietary interventions, and antiinflammatory agents such as lipoxygenase inhibitors.

Hopefully as we come to develop a better understanding of the pathogenesis of acne we can tailor even better treatment methods for this common and trouble skin disorder.

The information found on this website is not designed to replace the patient/physician relationship.

Researchers from the Department of Immunology at the Jagiellonian University Medical College in Cracow have published a study on the use of taurine bromamine (TauBr) as a topical treatment for acne vulgaris, particularly for patients’ whose acne is antibiotic resistant. They compared patients on Clindamycin gel, a common topical antibiotic, with patients on TauBr. A total of forty patients participated in the study for six weeks, applying the gels twice daily. Here is their finding:

“More than 80% of the patients markedly improved with both treatments, without any adverse effects observed. Both TauBr and clindamycin produced a significant reduction in inflammatory skin lesion counts (papules/ pustules). After 6 weeks, comparable reductions of acne lesions, 65% and 68%, were observed in the TauBr and clindamycin groups, respectively. In conclusion, these data support our concept that TauBr can be used as a topical agent in the treatment of acne vulgaris, especially in patients who have already developed antibiotic resistance.”

Treatment of acne with topical antibiotics is a mainstay in dermatology, but the emergence of resistant bacteria require alternatives. We encourage anyone with experience in taurine bromamine to comment.

The information found on this website is not designed to replace the patient/physician relationship.